Provider Demographics
NPI:1235600362
Name:SICOTTE, MARIE LYSE (FNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LYSE
Last Name:SICOTTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:LYSE
Other - Last Name:SICOTTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3800 SW 34TH ST APT C27
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2533
Mailing Address - Country:US
Mailing Address - Phone:207-577-9220
Mailing Address - Fax:
Practice Address - Street 1:37 GRAY BIRCH DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6105
Practice Address - Country:US
Practice Address - Phone:207-577-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily